Objective To determine whether re-feeding of gastric residual volumes reduces the time needed to achieve full enteral feeding in preterm infants. Design Parallel-group randomised controlled trial with a 1:1 allocation ratio. Setting Regional referral neonatal intensive care unit. Patients 72 infants of gestational age 230/7 to 286/7 weeks receiving minimal enteral nutrition (<24 mL/kg/ day) during the first week after birth. Interventions Infants were randomised to either be re-fed with gastric residual volumes (Re-feeding group) or receive fresh formula/human milk (Fresh-feeding group) whenever large gastric residual volumes were noted. Main outcome measure The primary efficacy end point was time to achieve full enteral feeding (≥ 120 mL/ kg/day) after randomisation. Results The mean time to full enteral feeding was 10.0 days in the Re-feeding group and 11.3 days in the Fresh-feeding group (mean difference favouring refeeding: -1.3 days; 95% CI -2.9 to 0.3; p=0.11). The composite safety end point of spontaneous intestinal perforation, surgical necrotising enterocolitis, or death occurred in 6 of 36 infants (17%) in the Re-feeding group versus 10 of 36 infants (28%) in the Freshfeeding group ( p=0.26). Conclusions Re-feeding gastric residual volumes in extremely preterm infants does not reduce time to achieve full enteral feeding. This trial suggests that refeeding might be as safe as fresh feeding, but further research is needed, due to lack of sufficient statistical power in this study for safety analysis.